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Outcome of intra-arterial thrombolysis in patients with diabetes and acute lower limb ischemia : a propensity score adjusted analysis

Author:
  • Talha Butt
  • Anders Gottsäter
  • Jan Apelqvist
  • Gunnar Engström
  • Stefan Acosta
Publishing year: 2017-10-04
Language: English
Pages: 475-480
Publication/Series: Journal of Thrombosis and Thrombolysis
Volume: 44
Issue: 4
Document type: Journal article
Publisher: Springer

Abstract english

The presence of diabetes mellitus is rarely addressed in acute lower limb ischaemia (ALLI). The aim of this study was to evaluate the outcome of local intra-arterial thrombolysis for ALLI in patients with diabetes mellitus (DM). Outcome of all thrombolytic events performed in an endovascular first-strategy centre during a 13-year period between 2001 and 2013 in patients with ALLI were followed to January 2017. A propensity score adjusted analysis was performed to evaluate results in patients with (n = 83) versus without (n = 316) DM. Patients with DM were younger (p = 0.001), more often women (p = 0.014), more often had renal insufficiency (p = 0.041), foot ulcers (p < 0.001), and thrombosis (p = 0.032) than the patients without DM. At presentation, patients with DM had a lower degree of ischemia judged by the Rutherford classification, compared to those without DM (p = 0.023). None of the 83 diabetic patients had a popliteal artery aneurysm, compared to 25 (7.9%) of the 316 patients without DM (p = 0.008). The amount of tPA administered to patients with DM was higher than to patients without DM (p = 0.03). In the propensity score adjusted analysis, patients with DM had a higher rate of major amputation at 1 (OR 2.52; 95% CI 1.22–5.20) and 3 years (OR 2.52; 95% CI 1.26–5.04), and a lower amputation-free survival at 3 years (OR 0.46; 95% CI 0.25–0.85), than those without DM. Patients with DM presenting with ALLI differ in clinical characteristics, presentation, and aetiology compared to patients with DM, and have a higher rate of major amputation and lower amputation-free survival rate after intra-arterial thrombolysis.

Keywords

  • Endocrinology and Diabetes
  • Cardiac and Cardiovascular Systems
  • Acute lower limb ischemia
  • Diabetes mellitus
  • Propensity score adjusted analysis
  • Thrombolysis

Other

Published
  • ISSN: 0929-5305
E-mail: jan [dot] apelqvist [at] med [dot] lu [dot] se

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